Empirical relations between sense of coherence and self-efficacy, National Danish Survey.

Salutogenic orientation is a health promotion paradigm focusing on the resources of the individual. This study analyzed the relationship between sense of coherence (SOC) and self-efficacy (SE) based on population data. By conducting an empirical analysis of the two models, we wanted to see whether we could make a valid judgement as to whether both SOC and SE could be utilized in health promotion practice, or whether one is preferable to the other. The study population was randomly selected from the Danish Central Population Register and consisted of five birth-year cohorts (1920, 1930, 1940, 1965 and 1975). The study used the 13-item SOC scale and the general SE scale. The main findings were that SOC score increased by age cohort (p = 0.0004), and there is a positive and graded correlation between SOC and SE (r = 0.39; p < 0.0001) and adjusted OR = 10.3 (CI = 6.7-15.4). We found the strongest association at the lowest level of SOC. For health promotion practice, this finding signifies the importance of focusing on improving SOC in people with a low SOC score, as they are most in need and most likely to increase their SOC level. The finding of higher SOC scores in the older age cohorts indicates that SOC changes over lifetime. Public health work focusing on lifestyle change by increasing SOC can be effective throughout life, however early intervention is important. The finding of a positive correlation between SOC and SE indicates that health promotion altering one of the constructs is paralleled in the other.

Liver Abscess following Hematogenous Transmission due to Rectal Foreign Body Perforation.

Liver abscess caused by hematogenous transmission from a gastrointestinal perforation by a foreign body is a rare but life-threatening condition. We present the case of a 57-year-old male with a pyogenic liver abscess generated on the basis of a foreign body perforation of the rectum. This has not been reported previously. During the examination of the patient, computed tomography scan showed not only the liver abscess but also an inflammatory presacral process, which communicated with the rectum through a 6.5-cm-long foreign body. Subsequent sigmoidoscopy showed a toothpick placed transmurally in the rectum; the toothpick was removed endoscopically. We discuss the importance of computed tomography scans and colonoscopies in relation to liver abscesses of unknown etiology, including the importance of detecting possible perforation caused by possible foreign bodies, polyps or cancer.

Less tachycardia during transnasal versus conventional gastroscopy.

INTRODUCTION: Transnasal endoscopy is well tolerated, but physiological benefits compared with conventional gastroscopy have not been studied in detail. The aims of this randomised study were to evaluate cardiopulmonary features, patient tolerance, and the endoscopist's evaluation of transnasal versus conventional endoscopy. MATERIAL AND METHODS: Patients were randomized to either a conventionally sized transoral (50 patients) or to a transnasal endoscopy (48 patients). Pulse rate and oxygen saturation were registered as well as the patient's tolerance and the endoscopist's evaluation of the procedure. RESULTS: The success rate for transnasal gastroscopy was 77%, mainly because of nasal stenosis. The per- and post-endoscopy pulse rates of the conventional group were elevated compared with those of the transnasal group (p = 0.04 and p = 0.02). Procedural discomfort in the two groups was similar, but significantly fewer transnasal patients reported gagging (p < 0.01). The endoscopists evaluated the technical features as good even if they did not reach those of conventional gastroscopy (p < 0.05). CONCLUSION: In this study, transnasal gastroscopy was technically inferior to conventional gastroscopy. There was no benefit in terms of patient comfort, except for less gagging. A lower stress response was indicated by significantly lower pulse rates during transnasal than during conventional gastroscopy, but the clinical relevance of this finding needs to be further investigated.

[Intestinal duplication--an important differential diagnosis to intussusception]. / Intestinal duplikatur en vigtig differentialdiagnose ved invagination.

This is a case report on a 6-month-old child with an intestinal duplication cyst (ID), initially diagnosed as intussusception. As the patient failed to improve clinically after an apparently successful enema reduction, surgery was performed and an ID was found causing compression and strangulation of the ileum. ID should be considered in small children presenting with acute abdomen. This history also emphasises the need to consider alternative diagnosis to intussusception when initial enema reduction fails to relieve symptoms.

[Training in basic laparoscopic technique and implementation of diagnostic laparoscopy]. / Oplaering i basal laparoskopisk teknik og implementering af diagnostisk laparoskopi.

INTRODUCTION: Diagnostic laparoscopy (DL) is performed when the clinical diagnosis is acute appendicitis. Upon the perioperative diagnosis of appendicitis, laparoscopic appendectomy (LA) is performed. The aim of this study was to monitor the general implementation of a surgical procedure not previously universally utilized for this operative indication and determine whether DL was suitable for training basic laparoscopic abilities. METHODS: After discussing the relevant literature, surgical technique and aim and design of the study, DL was introduced. In the period 1 September 2002 to 1 March 2004, 100 patients with the diagnosis of acute appendicitis were included in the study. RESULTS: Out of the 19 residents included in the study, 14 performed DL, with 9 also performing LA. The percentage of DL increased to 66% during the study period. After an average of two supervised DLs, the surgeons were able to perform DL without supervision. Supervision was done primarily by the attending surgeons. Of the 100 patients operated on, 63 underwent appendectomy; 39 were performed laparoscopically and 24 were done by conventional appendectomy preceded by DL. Postoperative complications occurred in five patients in the OA group, three in the LA group and none in the DL group. The operative time was comparable with that published in the literature. The perioperative diagnosis of appendicitis was confirmed histologically in 92% of the cases. DISCUSSION: DL had a short learning curve. The surgeons were able to make a correct diagnosis laparoscopically. Supervision was performed primarily by attending surgeons. It is concluded that DL is suitable for training basic laparoscopic skills.

[Organization of the preoperative patient's course in ambulatory laparoscopic cholecystectomy]. / Organisationen af det praeoperative patientforløb ved ambulant laparoskopisk kolecystektomi.

INTRODUCTION: The aim was to describe the organisation of an out-patient clinic for patients with gallstone disease in a day-surgery department and to evaluate the collaboration between admitting doctors and the hospital concerning the preoperative course. MATERIAL AND METHODS: 101 patients who had gallstone disease were admitted consecutively to the out-patient clinic. Information provided by the admitting doctors regarding the history of the disease, the blood-samples and the ultrasound was registered. Information of the treatment was subsequently obtained from medical records. RESULTS: On the admission 15% had symptoms, in 28% there were results of the liver function-test and in 56% there were results of ultrasound on the liver, gallbladder and pancreas. 46 patients were direct scheduled for surgery without further investigation and eight patients were finished without any treatment. In total 65 patients were operated, 23 patients were finished without any treatment, five patients were further elucidated and in eight cases no decision were taken concerning treatment by the end of the study. DISCUSSION: It was possible to schedule surgery at the first consultation in only 50% of the patients admitted with gallstone disease. The reason was mostly missing information from the liver function test or the ultrasound examination of the liver and bile ducts. Collaboration between the general practitioners and the hospital is of importance to achieve a rational preoperative evaluation of patients admitted with gallstone disease.

[Ventral herniotomy. Development of surgical technique and effect on the frequency of recurrence]. / Ventralherniotomi. Udvikling af operativ teknik og effekt på recidivfrekvens.

The surgical journal, Repair of Ventral Hernias, was reviewed with regard to recurrence of hernia. Ventral hernias must be operated on with a tension-free technique. It is recommended that hernias larger than 4 cm are repaired with mesh. A randomised, controlled trial has yet to be carried out to determine whether even small hernias should be repaired with mesh. Controlled and uncontrolled studies have shown that the use of mesh to repair larger hernias results in a lower recurrence rate. The operative technique with the mesh placed to bridge the wall defect gives a higher rate of recurrence than does an overlap technique. The overlap of the mesh and its placement in relation to the different layers of abdominal wall are not defined. The laparoscopic operation using the overlap technique and intraperitoneal mesh has shown a lower recurrence rate than the open technique. However, a randomised, controlled study comparing the laparoscopic and open overlap technique over a long follow-up period still needs to be conducted.

[Laparoscopic treatment of a benign hepatic cyst]. / Laparoskopisk behandling af benign levercyste.

We present a case of laparoscopic treatment of a symptomatic solitary hepatic cyst and the use of preoperative laparoscopic ultrasound scanning and ultrasonic scalpel.